Wednesday, May 27, 2009

There are real and fake smiles that can be distinguished visually, if you know how, and it turns out that there are real and fake laughs. William Hudenko, a clinician and researcher, patiently explained this to me at IMFAR 2009. Real laughs are "voiced" versus fake laughs that are "unvoiced" and these two kinds of laughs can be distinguished acoustically.

Hudenko et al. (in press) describe voiced laughs as having a "tonal, song-like quality" and as "strongly associated with positive affect," while unvoiced laughs are "largely atonal and noisier." Instead of reflecting a person's genuine emotions, unvoiced laughs are hypothesized to reflect various social signals.

When nonautistics laugh, about half the time their laughs are unvoiced. So how do autistics laugh?

Hudenko and his colleagues collected a lot of laughs from autistic children and two groups of nonautistic children (matched on chronological age, and matched according to vocabulary test age equivalents). Laughs were elicited in a 10-minute "laugh assessment sequence" in which "an examiner playfully interacted with each child."

The results? Autistics laughed just as much as nonautistics. The sole difference between autistic and nonautistic laughs was in proportion of voiced laughs. While on average, 97% of autistic children's "laugh episodes" were voiced, only 63% and 47% (age-equivalent and chronological age groups respectively) of nonautistic children's laughs were voiced. And about half the autistic children produced only voiced laughs.

...children with autism routinely produce fewer types of laughs than typically developing children because their laughter is more closely linked to their internal experience of positive affect.

If this is so, then the autistic children in this study expressed more positive emotion--more genuine happy affect--in interacting with another person than did the nonautistic children. Hudenko et al. also refer to an earlier study which found, in the typical population, more positive responses to voiced versus unvoiced laughter. Nonautistics prefer voiced laughter.

Given prevailing standards in the autism literature (arising from prevalent standards of autism advocacy), no one should be surprised at how Hudenko et al. interpret their findings. The authors imply, in the absence of any evidence in this direction, that all this happy, genuine, engaging autistic laughter is unlikely to be socially "appropriate." Unfortunately, according to the authors, autistics "are not using laughter in a socially subtle manner." And here is the paper's unfounded concluding sentence:

In fact, by using laughter in a less social manner it may be that this expressive pattern actually contributes to the social deficits exhibited by children with autism instead of serving to facilitate connections with others.

But the story doesn't quite end there. I ran into Dr Hudenko at IMFAR because he and one of his colleagues had a poster (abstract is here), a follow-up of sorts. In this new and as yet unpublished study, recordings of voiced and unvoiced autistic and nonautistic laughs were played for 135 nonautistic college-aged students. The students were asked to rate their "affective response" to each laugh on a scale from strongly negative to strongly positive. In a different task, the students were asked whether each recorded laugh came from an autistic or nonautistic child.

The results? The students rated their responses to autistic laughs as being significantly more positive than their responses to nonautistic laughs. Interestingly, this held true even when voicing--whether laughs were voiced or unvoiced--was accounted for. And when asked to do so, the nonautistic students could tell autistic and nonautistic laughs apart. The students performed above chance on this task, while only about one-fifth of them believed they could make this distinction.

So Hudenko et al. (in press) contend that autistics' way of laughing is defective and detrimental--a presumed contributor to autistics' presumed social deficits. This in turn implies that ideally, autistics would not have such engagingly positive, genuine and distinctive laughs, and instead should have the only "right" kind of laughter, the kind which characterizes nonautistics. But according to Dr Hudenko's IMFAR follow-up study, "improving" autistics this way would result in their laughter being less preferable to nonautistics than is currently the case.

Reference:

Hudenko, W., Stone, W., & Bachorowski, J. (2009). Laughter Differs in Children with Autism: An Acoustic Analysis of Laughs Produced by Children With and Without the Disorder Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-009-0752-1

How behavior analysis will help save the planet... How behavior analysis will help save the economy... How behavior analysis will help save lives... How behavior analysis will help us understand each other...

Looking around the 2009 ABAI convention program, you will in fact bump into the notion that ABA can, and should, save the world. For instance, from Tutorial #287:

This presentation will inspire a reconsideration of how ABA can save the world... the presenter will discuss the relevance of courage and compassion in realizing the potential of ABA to save the world...

Symposium #403 at this year's ABAI convention is chaired by Matthew Israel (Judge Rotenberg Center), and is titled:

The Use of Contingent Skin Shock in Treating Behaviors Other than Aggression and Self-Abuse

The three presenters in Symposium #403 are all from the Judge Rotenberg Center. Nathan Blenkush, BCBA-D (this is the highest status certification for behaviour analysts currently available), describes his presentation this way:

There are a number of topographies of problem behaviors that are intractable to standard behavioral and pharmaceutical interventions that cannot be classified as aggressive or self-abusive behaviors. In this presentation, we will describe the successful treatment of a variety of intractable behaviors using Contingent Skin Shock. First, we will review the literature associated with the use of CSS to treat non-aggressive and non-self injurious behaviors. Second, we will discuss how problem behaviors such as property destruction, major disruption (e.g. yelling, tantrums,), noncompliance or any other behavior in excess can severely harm students and completely interfere with treatment, education, and social development. Finally, we will present a series of case studies that will illustrate the use of CSS to treat these types of behaviors. Finally, we will discuss the treatment of these behaviors within the framework of the right to effective treatment.

Robert Von Heyn, BCBA-D, describes his presentation this way:

We describe the use of supplementary Contingent Skin Shock (CSS) to address intractable behaviors other than aggression and self-abuse. From 2003 to 2006, CSS was added to the programs of 72 students. However, in June of 2006, the New York State Department of Education put into effect regulations that limited the use of skin shock to aggressive and self-injurious behaviors. Subsequently, a federal judge temporarily blocked these regulations at the request of the parents and treatment resumed for most of these students. Here we first describe the initial effect of adding CSS to the students programs. Second, we describe the effect of the temporary suspension of the treatment for behaviors such as major disruption, property destruction, and noncompliance. Third, we describe how the regulations affected the treatment of problem behaviors such as aggression and self-abuse. Finally, we describe the effect of the reintroduction of CSS treatment, following intervention by a federal judge, for destructive, major disruptive, and noncompliant behaviors.

And Nick Lowther describes his presentation this way:

In June of 2006, the New York State Department of Education put into effect a set of regulations related to the use of aversive interventions such as Contingent Skin Shock (CSS). The regulations limited the use of CSS (and other procedures such as mechanical restraint) only to aggressive and self-injurious behaviors. The regulations also placed a number of other restrictions on the use of procedures such as CSS. However, after 9 weeks, in September of 2006, a federal judge temporarily blocked these regulations at the request of the parents. In this presentation, we discuss the impact these regulations had on the students at the Judge Rotenberg Center. In addition, the history of this lawsuit will be discussed. Finally, we will provide an update regarding the current status of the suit.

Symposium #403 comes with a written "Purpose," which adds little to the above except the false information that existing evidence supports the use of contingent electric shock for some behaviours. It is true that the current edition of the major ABA textbook (Cooper et al., 2007) promotes the use of electric shock with developmentally disabled people. But setting aside ethical issues which should not be set aside, Cooper et al. (2007) cite no good quality evidence arising from good experimental design, or anything even close, in support of this practice. In this major ABA textbook, very poor standards of science and ethics, which are known to harm human beings, coincide and are promoted as what autistics and other developmentally disabled people deserve.

In contrast there are scientists who, at least in some instances, have regarded autistics and other developmentally disabled people as deserving the benefit and protection of recognized standards of science and ethics. These scientists have unsurprisingly revealed the extremely well-established and well-recognized (outside of autism and ABA areas) importance of good experimental design (Tyrer et al., 2008; abstract is here, short description here).

I will not be attending the 2009 ABAI convention. The publicly available statements by the JRC presenters, two of whom are BCBAs at the highest level, are provided unedited here to speak for themselves. While the JRC's specific practices are the subject of controversy in some quarters, their stated standards are widely promoted as the only way to save autistics, and are not in any way unique to the JRC.

Thursday, May 14, 2009

You have seen the autism recovery story inthemedia. Bloggers havejumpedin too. I was at IMFAR 2009 in Chicago and saw the educational symposium presentation by Deborah Fein that was the stated cause of all the excitement.

But in her presentation, as in her abstract, Dr Fein did not associate the findings she reported with any kind or quantity of autism intervention or treatment. When speaking at IMFAR, she expressed doubt that this in fact could be done.

Dr Fein clearly added more information when speaking with the media. She expressed her view that recovery from autism, what Dr Fein calls "optimal outcome," was associated with early intensive ABA-based autism interventions. Like all researchers, she is free to say what she wishes to the media.

However, her statements relating kinds and amounts of intervention to outcomes in autistic children are not supported by any of the data she chose to present at IMFAR 2009, either in her oral presentation or in a series ofrelatedposters.

Indeed her study design does not permit any conclusions about effectiveness of interventions, no matter how "effectiveness" is defined. She has not conducted a true experimental design in which well-known sources of bias can to some degree be accounted for and therefore the effects of interventions, their benefits and harms, can usefully be assessed.

In order to claim that conclusions can be drawn about the effectiveness of interventions in Dr Fein's study, as it has been presented, you have to be willing to reject and discard even the most basic standards of science. These are the basic standards that automatically protect and benefit nonautistics, the basic standards that were developed because without them people were harmed.

Two other aspects of what Dr Fein presented at IMFAR 2009 are noteworthy. One is that a major paper in the literature, published not long ago, reported a very high rate of what is now being called recovery from autism. To my knowledge, this paper did not make headlines.

Turner and Stone (2007) were looking at the stability of autism diagnosis at around age two years (mean age of 29 months). They carefully used various combinations within what is considered the gold-standard diagnosis: ADOS, ADI-R, and clinical judgment. And they found that early diagnosis, in their sample of 48 originally autistic children, was very unstable.

By age four (mean age of 53 months), only 53% of children originally given the specific diagnosis of autism retained this specific diagnosis, while only 68% were still on the autistic spectrum. The rest were not. That is a 32% rate of "recovery." Only 40% of children originally diagnosed with PDD-NOS at age two still had an autistic spectrum diagnosis by age four. That would be a 60% rate of "recovery."

The children whose age two diagnoses were unstable were largely still regarded as having difficulties, a finding that echoes Dr Fein's work, but they no longer could be diagnosed as autistic.

Turner and Stone (2007) attempted to associate instability of diagnosis (what is being called "recovery") with interventions received, but no association was found. They report:

All children in the sample received speech therapy, and the majority received additional interventions. There were no significant differences between the Stable and Change groups for the amount of speech therapy, t(46) = .30, p = .77, behavioral therapy, t(46) = .78, p = .44, occupational therapy, t(46) = 1.90, p = .06, special education, t(46) = 1.96, p = .06, or regular preschool, t(46) = .13, p = .90. Of the 6 children who received an average of 20 or more hours of intervention per week, 5 were in the Stable group and 1 was in the Change group.

In other words, few of the 48 originally autistic children in this study received what would be considered "intensive" intervention, and the majority of those who did kept their autism diagnosis.

In contrast, Turner and Stone (2007) found that diagnostic instability was related to earliness of diagnosis: the earlier the diagnosis, the more unstable it was.

The authors go on to discuss what may underlie the diagnostic instability they found while using the best available diagnostic standards. In fact there are many possible explanations. One point they do underline, however, is that given their findings,

...extreme caution must be taken when interpreting intervention findings that suggest ‘cures.’

And of course that would include intervention findings that suggest "recovery." This may be all the more so when diagnosis, and therefore intervention, is very early.

Also noteworthy is Dr Fein's use of the term "optimal outcome," a term she prefers to "recovery." Dr Fein and her colleagues have determined the criteria for optimal outcomes in autism, and these criteria assume that autistics who remain autistic are suboptimal. Remaining autistic is an undesired, unsatisfactory, inferior, suboptimal result.

According to Dr Fein, and those enthusiastically promoting her views, we know what an optimal human being is like, and this optimal human being is not autistic. An optimal outcome is not Stephen Wiltshire or Alex Bain or Daniel Tammet or Derek Paravicini or Hugo Lamoureux or Vernon Smith or Richard Bocherds or Danny Melvin or Tony DeBlois or janet norman-bain or Jessica Park or Temple Grandin or the large proportion of autistics found recently to have exceptional skills (Howlin et al., 2009) or me for that matter.

Indeed, Dr Fein's group has proposed loss of exceptional autistic skills as evidence for optimal outcomes. And given the great support Dr Fein's views have received, we should be in little doubt as to the goals of popularly demanded autism interventions, and the consequences for those of us who for whatever reason remain unrecovered. The decision as to which kind of human being is optimal and which kind is not has been made.

This practice is problematic in itself, but what is worse is that no questions are allowed when sponsors speak. Unlike every other speaker who presents at IMFAR, sponsors are considered to be above any kind of questioning or criticism.

This should not happen at a research conference. Nobody should be able to buy time to say whatever they wish, then refuse to take questions.

My suggestion is that if sponsors are to be given such a prominent place in the IMFAR schedule, they should be required to answer questions about the information and positions they put forward.

You can find the IMFAR 2009 program and abstracts, in different formats, via this page. Archives of abstracts from previous years can be found here.

This year I was involved in two abstracts. You can find them here and here. The first is below; the information in this abstract was updated, and therefore was slightly different, in the IMFAR poster we presented.

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Where Autistics Excel: Compiling An Inventory of Autistic Cognitive Strengths

Background: Until recently, there has been little interest in autistic cognitive strengths. Instead, autistic strengths revealed through comparisons between the performance of autistic and nonautistic individuals on various tasks have been largely reported or interpreted as evidence for autistic cognitive deficits (Baron-Cohen, 2005; Gernsbacher et al., 2006; Mottron et al., 2008). Also, there is currently no compilation of empirically documented autistic cognitive strengths as reported in the existing literature. Accordingly, little is known about the full range and quantity of autistic cognitive strengths or the variety and number of autistic individuals in which these strengths have been found.

Objectives: Our aim was to further understanding of cognitive strengths in the autistic population by identifying, quantifying and characterizing existing studies reporting these strengths.

Methods: We located and characterized papers published in peer-reviewed journals which reported autistic cognitive strengths. In order to be included, studies had to compare the performance of autistics to the performance of nonautistics on a task, and autistics had to be reported to perform better than their controls on the task. Studies specific to autistic savants and hyperlexics were excluded, as were probable but unclear reports of autistic strengths, and accidental findings arising from matching strategies. Autistic cognitive strengths originally reported and/or interpreted as deficits were included.

Results: In total, 52 distinct types of autistic cognitive strengths were found, reported in 71 papers (12 reporting two or more strength types) spanning from the 1970s to the present. Only 13 papers published prior to 2000 reported strengths, but at least five papers reporting strengths have been published every year starting in 2000, with the highest number per year in 2008 (N=13). Twelve of the 52 strength types were reported in at least two, and up to 10, papers, with the most replicated finding being superior performance in embedded figures tasks. While most strengths (N=36) were found via tasks using nonsocial information, several strengths involving social information (N=8) and language (N=7) were reported. Sample size for autistic groups ranged from 3 to 40, with a mean of 16, while mean age of autistic participants within samples ranged from 2 to 39 years. Total number of autistics, encompassing 81 different samples, was 1351, of whom 885 had the specific diagnosis of autism, while 130 were diagnosed with Asperger syndrome, and 336 were in the general “ASD” category. Of the 71 papers, 25 included autistic individuals judged to be intellectually disabled according to commonly used instruments, and 29 reported or interpreted one or more findings of autistic cognitive strengths as one or more deficits.

Conclusions: Numerous distinct autistic cognitive strengths, some of them highly replicated, in a wide range of areas, and displayed by a large number and great variety of autistic individuals, have been reported in the literature. Failing to acknowledge the importance of autistic cognitive strengths may impede efforts to understand autistic differences and assist autistic individuals. We recommend more consistent and transparent reporting and interpretation of autistic cognitive strengths and more attention to their importance.

Francesca Happé and Uta Frith, who organized the discussion meeting, write in the special issue's editorial that although "the association of autism with special talent, sometimes at the highest level, cannot be denied" it remains true that "special talents are still less researched and less well understood than other features of autism."

The long-standing lack of interest in what autistics do well is understated. For example, the commonly reported estimate that 10% of autistics have savant abilities dates back to a book chapter, involving an informal parent survey, published more than 30 years ago. If anything, the "Autism and Talent" special issue highlights the current, ongoing state of ignorance about the strong abilities that have been noted in autistics from the outset (Kanner, 1943; Asperger, 1944/1991; Scheerer et al., 1945).

In their special issue paper, Pat Howlin and her colleagues use very conservative methods to find exceptional skills in about one-third of a group of autistics originally diagnosed between 1950 and 1985. While noting this is "likely to be an underestimate," the authors can only ask, about the "particularly high" "rate of such unusual talents or skills" in autism,

"Why?"

Sixty-some years after unusual autistic abilities were first highlighted in the literature, their extent, nature, and importance remain strikingly neglected as subjects of research. This neglect and consequent ignorance is evident in the special issue. Throughout questions are raised that have long been deemed unimportant or irrelevant and so have largely gone unasked never mind unanswered.

In her paper, Pamela Heaton illuminates the price autistics pay for this long history of willful neglect and ignorance. She points to fascinating new evidence about autistics' advantage in perceiving musical timbre, adding to a wide body of work showing enhanced auditory pitch processing in autism. She shows that autistics "who do not meet criteria for savant skills... nevertheless possess considerable, but often unexploited, musical potential." And she concludes that autistics are being denied opportunities to develop their strong interests and abilities.

Our paper in the special issue (Mottron et al., 2009) proposes ways in which autistics' measurably atypical cognitive processes may--given the opportunity--lead to the development of savant abilities, which we see as autistic expertise. Again we have to note the fall-out from researchers' long-standing indifference to how autistics learn well:

However, it must also be acknowledged that the information autistics require in order to choose and generalize any given interest is likely to be atypical in many respects (in that this may not be the information that non-autistics would require), and may not be freely or at all available. In addition, the atypical ways in which autistics and savants learn well have attracted little interest and are as yet poorly studied and understood, such that we remain ignorant as to the best ways in which to teach these individuals (Dawson et al. 2008). Therefore, a failure to provide autistics or savants with the kinds of information and opportunities from which they can learn well must also be considered as explaining apparent limitations in the interests and abilities of savant and non-savant autistics

This account is in keeping with the failure of researchers to find consistent predictors of outcome among the characteristics of autistic individuals on which researchers have concentrated their attention (Howlin, 2005).

Kate Plaisted Grant and her colleague Greg Davis highlight in their paper, as we do in ours, how profoundly atypical autistic minds are. They conclude there is much to gain, for autistics and nonautistics, in acknowledging, understanding and encouraging autistics' strong abilities:

Research such as that described here makes this important point: savant abilities are relatively rare, but the skills observed in individuals with ASCs [autistic spectrum conditions] in many studies are common among the population with ASCs. These skills need as much training and encouragement as is given to any individual with talent in detailed processing, mathematics, engineering, design and so on. With such dedicated training, society, business and industry will reap the great benefits of the unusual minds of individuals with ASCs.